Multiple faces of the health transition

The ageing of population is often associated with strain of health system due to increasing healthcare utilization among elderly. The extent to which demographic mingles with non-demographic factors, however, was rarely addressed. This study aims at investigating the effects of demographic and non-demographic changes to the future healthcare utilization. Using individual and household level data from various national-level surveys, discrete choice models are used to estimate the propensity of use of healthcare for each population group specified by demographic and non-demographic characteristics, which is then projected to the future population. The study shows that the effects of demographic change are quite substantial in term of size and pattern of utilization. However, these effects can be either compounded or undermined by non-demographic factors, such as health insurance subscription and chronic diseases. The share of health care utilization among elderly is not as high as commonly been perceived. This study offers an insight that the effects of demographic change to healthcare utilization is not straightforward if we are to acknowledge that ageing progresses along with the non-demographic factors as the case in many developing countries.

It has been shown that there are meaningful similarities between causes of death responsible for the East-West mortality divide in Europe and cause-specific pattern of the socioeconomic mortality differences in England & Wales. It has been suggested that such remarkable similarities point to common threads that underlie the two types of disparities. These threads may be caused by contemporary behaviors and conditions, but also by early life conditions and risks accumulated over the life course. The present study provides a detailed look at mortality differences between Finland and Lithuania and compares mortality inequality between countries with mortality inequality within Finland. We examine similarities and differences in age- and cause-specific patterns of mortality inequality between total Finnish and Lithuanian populations and manual and non-manual occupation groups in Finland.

In spite of an increasing demand for reliable information of cause and distribution of mortality, civil registration systems in most developing countries still do not yield the complete and accurate data required for the direct estimation of mortality rates. In India, where civil registration system and SRS lacks sufficient power to produce reliable estimates of mortality across life stages. Our knowledge of age-pattern of mortality depends largely on cross-sectional data from censuses /surveys providing us information on recent deaths in the households. Most of the household surveys are not designed to derive mortality estimates over all ages. This paper aims to fill this gap by analyzing large scale household survey (DLHS-III) conducted in 2007-2008 in India. We have computed age specific mortality rates for all age groups after adjusting infants/child exposure period by “Date by Year cohort” method. Brass two parameter logit model has been used to graduate non-linearity of estimated age specific mortality rates. This study clearly suggests that mortality estimates derived from “Recent household death" approach using district level data yield comparable results with official Sample registration system Death rates.

Self-rated health (SRH) has consistently been associated with mortality, disability and morbidity. We investigated proximal determinants of SRH. Data come from baseline surveys of women (15-44y) and men (20-59y) in three (Ethiopia, Ghana and Uganda) of six sites of the Family Health and Wealth Study, an ongoing longitudinal study. We considered three proximal determinants of self-rated health: systolic blood pressure; non-communicable disease; and health problems. The effective analytic sample was as follows: Ethiopia (943 women; 959 men); Ghana (791 women; 747 men); and Uganda (463 women; 442 men); representing 91-99% of the total sample. Data were explored to observe patterns in the variables and relationships of interest and generate frequencies. Following estimation of ordinal logistic regressions, the presence of one or more health problems was the only proximal determinant that remained significantly associated with SRH in both men and women across the three sites. As these study cohorts are being followed over time, we expect that future findings will more fully inform the influence of proximal determinants on self-rated health.

People often consider the question of where the limits of the lengths of human life lie. Length of life is usually expressed as the life expectancy at births (or more generally the life expectancy at exact age x years). The values of the life expectancy at births and of the modal age at deaths differ from one another and their development trends in time also differ. This is due first and foremost to the fact that the life expectancy at births is the average age of deaths in the stationary population, which is strongly influenced by the extreme values, especially the level of infant mortality. In contrast to this, the modal age at deaths is given by the age at which people most frequently die (with the exception of childhood). The term modal age at deaths was already introduced by Ch. Bernoulli and defined precisely by Lexis (1877) as the age when the number of deaths in adulthood (in the life tables) attains its maximum. The modal age at deaths is often used as a characteristic of longevity. This paper will analyse and compare trends in the development of the life expectancy and the modal age at deaths in European countries using various methods for the smoothing and modelling the mortality at higher ages. An estimate will also be made of the possible future development of mortality with the help of the analysis of time series.

Over the last forty-five years, Moldova failed to progress in life expectancy at birth. Disregarding the wide fluctuations linked to the 1985 anti-alcohol campaign and the social and economic crisis of the 1990s, the general trend in life expectancy is stagnating among males and slightly improving among females. Interpreting recent mortality changes in the light of long-term trends provides an insight into the reasons of the health crisis affected Moldova like other former USSR republics from the mid-1960s. However, the periodic changes in classification of causes of death break the continuity of death time series. To assure their consistency we used a special reconstruction method (Meslé and Vallin, INED). Moreover, unlike other European countries of the former USSR, the quality of death registration in Moldova in infancy and at older ages for the 1960s and 1970s is rather questionable. The analysis of cause-specific mortality trends will be produced here after corrections for under-registration. After a long period of deterioration mixed with large fluctuations as in other former USSR countries, the recent favorable trends give hope but not yet the proof of a start of sustainable positive trajectory.

Reduction in child malnutrition is central to economic and social development in any country as it has dire ramifications to physical, psychological and mental development of individuals over the life course. Child malnutrition is also associated with higher morbidity and mortality incidence. Therefore, it is imperative to have knowledge of its correlates and determinants. Examination of determinants of child nutrition at different points of its distribution has better policy implications than investigating predictors on average value. Using NFHS-III (2005-06) data, this study investigates determinants of nutritional status -measured by standard anthropometric indicators- of children aged 0-59 months in India using quantile regression approach. Results show that age and birth order is negatively associated with height for age and weight for age z-scores but these are positively associated with the weight-for-height z-scores. Mothers’ nutrition, educational level and better household environment are positively associated with the nutrition z-scores but these factors differential effects at different points of the conditional distribution of the anthropometric z-scores.

This study focuses on the contribution of leading causes of death to the general phenomenon of mortality compression in Canada, a topic that has received very limited attention thus far. We analyse the evolution through time of the adult modal age at death (M) and the standard deviation above the mode (SD(M+)) for each leading cause of death in Canada (1974-2008), thanks to detailed data by cause, sex, single year of age and calendar year obtained through a special governmental initiative aiming for greater data access. Changes in the adult age-at-death distribution, such as described by M and SD(M+), are evaluated using a novel nonparametric smoothing approach known as the P-splines method, that we specifically adapt to the context of cause of death analysis. Preliminary results show that between 1974 and 2008, M has increased while SD(M+) has decreased for cancer and heart diseases, Canada’s top two leading causes of death.

Life expectancy is increasing in most high-income countries. The development is not uniform, though. Whereas some countries experienced steady progress during recent decades, others have periods of stagnation and, eventually, phases of catching up.

The aim of our paper is to investigate whether comparable developments
in life expectancy are based on the same underlying mortality dynamics. We use surfaces of rates of mortality improvement as our tool of analysis. Based on two-dimensional plots of smoothed death rates, our ``maps'' depict the rate of mortality change over time. We argue that this approach provides an excellent exploratory tool to visually analyze mortality dynamics, in particular to detect age-, period-, and cohort-effects. Preliminary results demonstrate for international comparisons that periods of stagnation followed by rapid increases can be caused by cohort factors (e.g. Denmark) as well as by period factors (e.g. East Germany).

An analysis by major causes of death for the United States shows that
antagonistic cohort effects were instrumental for the slow life
expectancy increase during the 1980s and the 1990s: If negative cohort
effects of respiratory diseases and cancer had been absent, life
expectancy would have increased much faster due to improvements in
survival for heart diseases.

The level of nutrition of women is associated with a set of factors like socio-cultural, and economic. The status in the family and in the society and decision making autonomy of women contribute to overall health outcomes on themselves and also on the children. The result focused whether any significant relationship exits between decision making autonomy and level of nutrition in the Dhaka district where level of urbanization is about 92 percent.
Decision making autonomy is an important component of women’s empowerment. The proportion of Chronic Energy Deficiency (CED) women reduce as women participated more decisions in the family relating to health, major events etc. Not only the level of malnutrition decreases along with autonomy, but also the proportion of obesity (BMI>=25) reduces. These two categories of women (CED, Obese) are more vulnerable for maternal morbidity and mortality.
The logistic regression (multivariate) analyses show that likelihood to have CED is lower in higher level of decision making autonomy i.e. women with higher autonomy have lower chance to have chronic energy deficiency and vise-versa.
The findings demonstrated that wider decision making made by women in the family enabled them to improve their nutritional level (low malnutrition and reduce obesity).